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Withholding or withdrawing therapy in intensive care units: an analysis of collaboration among healthcare professionals

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Abstract

Purpose

The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU).

Methods

A questionnaire survey was conducted in seven hospitals in the Region of Southern Denmark, including six regional and four university ICUs. Four hundred ninety-five nurses, 135 intensivists, and 146 primary physicians participated in the study. The primary physicians came from two regional hospitals.

Results

The unified response rate was 84%. “Futile therapy” and “Patient’s wish” were for all participants the main reasons for considering withholding or withdrawing therapy. Of primary physicians 63% found their general experience of collaboration very or extremely satisfactory compared to 36% of intensivists and 27% of nurses. Forty-three percent of nurses, 29% of intensivists, and 2% of primary physicians found that decisions regarding withdrawal of therapy were often, very often, or always unnecessarily postponed. Intensivists with ICU as their main workplace were more satisfied with the collaboration and more rarely found that end-of-life decisions were changed or postponed compared to intensivists who did not have ICU as their main workplace.

Conclusion

Nurses, intensivists and primary physicians differ in their perception of collaboration and other aspects of withholding and withdrawing therapy practises at the ICU. Multi-disciplinary patient conferences, nurse involvement in the decision-making process, and guidelines for withholding and withdrawing therapy are recommended.

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Acknowledgments

The authors thank all staff for taking part in the study and the Region of Southern Denmark, Lillebaelt Hospital, Denmark, and the philanthropic foundation TrygFonden, Denmark, for supporting the study.

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Authors and Affiliations

  1. Department of Anaesthesiology, Vejle Hospital, (V66), Kabbeltoft 25, 7100, Vejle, Denmark

    Hanne Irene Jensen & Helle Ørding

  2. Health Services Research Unit, Lillebaelt Hospital/IRS University of Southern Denmark, Skovvangen 2-8, 6000, Kolding, Denmark

    Hanne Irene Jensen & Jette Ammentorp

  3. Department of Biostatistics, Aarhus University, Building 1261, Bartholins Allé 2, 8000, Aarhus C, Denmark

    Mogens Erlandsen

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  1. Hanne Irene Jensen
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  2. Jette Ammentorp
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  3. Mogens Erlandsen
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  4. Helle Ørding
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Correspondence to Hanne Irene Jensen.

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Jensen, H.I., Ammentorp, J., Erlandsen, M. et al. Withholding or withdrawing therapy in intensive care units: an analysis of collaboration among healthcare professionals. Intensive Care Med 37, 1696–1705 (2011). https://doi.org/10.1007/s00134-011-2345-7

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  • DOI: https://doi.org/10.1007/s00134-011-2345-7

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